[The Hypertension Optimal Treatment (HOT) study: results of 12-month therapy related to age].
OBJECTIVE
The prospective, randomized multicentre HOT study (Hypertension Optimal Treatment) is at present being undertaken in 26 countries. The cardinal questions to be answered were: (1) the relationship between three targeted diastolic pressures (< or = 90, < or = 85 and < or = 80 mm Hg, respectively) and cardiovascular morbidity and mortality rates among hypertensives; and (2) the effect of low dosage aspirin (75 mg daily) on morbidity and mortality rates, compared with a placebo.


METHODS
A total of 19,193 patients (9056 women, 10,137 men; age range 50-80 years) with a diastolic blood pressure of > or = 100 to < or = 115 mm Hg were randomized. Antihypertensive treatment was begun with the calcium-channel blocker felodipine (5 mg once daily; step 1). When the target could not be reached at this dosage, an angiotensin-converting enzyme inhibitor (ACEI) or beta-receptor blocker was added (stage two), after which felodipine, 10 mg daily, could be given, if necessary (step 3). Any necessary changes in dosage (step 4) were made according to a prescribed plan. As fifth and final step a diuretic could be additionally administered. One-year results are now available for all patients and reported here. Results of older patients (> or = 65 years, n = 6113) were compared to those of younger patients (< 65 years, n = 13,080).


RESULTS
Average diastolic pressure in the previously < or = 90 mm Hg group had been reduced to 86 mm Hg, in the < or = 85 group to 83 mm Hg, and in the < or 80 mm Hg group to 81 mm Hg. The percentage proportion of patients in whom the targeted pressures had been reached after 12 months of treatment were: 84% for the < 90 mm Hg group, 72% in the < 85 mm Hg group and 57% in the < 80 mm Hg group. In a subgroup of elderly patients (> 65 years, n = 6113) the corresponding percentage proportions were higher: 86%, 76% and 61%. Side effects were noted only rarely, despite the intensive treatment (> 65 years and < 65 years): ankle oedema in 2.6% and 3.0%; and cough in 1.3 and 0.8%, an overall incidence of > or = 1%. The same treatment (with felodipine) was still being given after one year to 88% of all patients.


CONCLUSIONS
These results after one year indicate that most patients well tolerate consistent blood pressure reduction. This raises the hope that the primary questions of the study can be answered.
Kolloch
R E
RE
Medizinische Klinik, Krankenanstalten Gilead, Bielefeld.
Rahn
K H
KH
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use; D003971:Diastole; D004232:Diuretics; D015736:Felodipine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010919:Placebos; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D010919:Placebos; D010975:Platelet Aggregation Inhibitors; D049993:Sodium Chloride Symporter Inhibitors; D006852:Hydrochlorothiazide; D015736:Felodipine; D001241:Aspirin
Die "Hypertension Optimal Treatment" (HOT)-Studie. Behandlungsergebnisse nach zwölfmonatiger Therapie in Abhängigkeit vom Alter.